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Government Public Attorney in Minneapolis, MN

Fairview Health Service Feb 04,2016 Jan 13,2016 Location USA Minneapolis MN
This job is expired...

In-House

Attorney

Government / Public Law

Litigation - Whistleblower - CFTC

5-7 yrs required

Profile

Manager - Compliance and Licensing Duties: Supervise and support Fairview Pharmacy Services (FPS) - pharmacy benefit management's (PBM) compliance program, including licensing, government programs and regulatory affairs activities. Oversight and development of effective standard operating policies, procedures and best practices across the organization to promote compliance with applicable laws and contractual obligations. Ensure formal documentation of this information to support effective and efficient operations. Review and revise policies and procedures as legally and procedurally required and when legal, regulatory and contractual changes occur to ensure compliance with requirements and obligations. Oversight and review of all required delegated entity policies and procedures for regulatory and procedural compliance with state and federal law and ClearScript business practices and requirements. Communicate and ensure understanding of policies and procedures within operations. Compliance Committee Participation: Act as liaison to FPS Compliance Committee. Represent as appropriate. Provides updates to Compliance Work Plan on a regular basis. Participate in FPS annual risk assessment. Attend Compliance Committee, FPS Ambulatory and Service-Line policy and procedure meetings as scheduled. Government Programs Compliance Oversight: Review, understand and provide guidance for new government programs laws and regulations for those that may be applicable to assigned lines of business. Review, understand and provide guidance for health plan management system (HPMS) memoranda applicable to government programs business, including any associated analysis provided by downstream contracted business associates. Oversee and ensure communication with leadership as necessary, information regarding all new and updated applicable government programs regulations and guidance. Oversee activities of Government Programs Compliance Analyst regarding business implementation and execution of regulations and guidance. Provide assessment and oversight for all changes required that may affect government programs business. Licensing: Participate in new client development planning to ensure proactive legal and regulatory compliance and licensing requirements are identified and addressed. Manage all new and renewal Third Party Administrator (TPA) or Pharmacy Benefit Management (PBM) licensing and registration with appropriate regulators. Identify applicable licensure requirements. Prepare new or renewal TPA/PBM application and coordinate supporting documentation and fee payments as necessary. Maintain licensure recordkeeping and database. Evaluate and manage other required licensure or registration or its downstream entities as necessary: Utilization Review Management; Employee Benefit Plans; ;Business licenses; and others as identified. Support efforts in seeking or maintaining external accreditation where necessary. Manage accurate and timely filings of required annual reports in any state where required. Monitor the designated registered agent for information affecting. Evaluate compliance requirements and execute necessary action to ensure compliance. Elevate issues as appropriate. Monitor and coordinate with Revenue Management the submission of all franchise tax requirements. Regulatory Affairs: Provide business teams with regulatory research, interpretation, and compliance expertise with State and Federal regulations, including regulatory change management efforts needed within the business. Solicit legal counsel to review and interpret complex legislation, proposed and final regulations and apply knowledge and expertise for its clients in order to mitigate compliance risks. Provide guidance, and expertise to leadership regarding compliance with State and Federal regulations, including: Affordable Care Act, Medicare Part D, False Claims Act, Fraud, Waste and Abuse and Stark, HIPAA Privacy and Security. Provide oversight and guidance for designated clients' compliance and regulatory issues, in coordination with the appropriate client engagement staff, internal business teams and/or Government Programs Compliance Analyst. Triage and track legal issues and requests elevated by business operations, to assess necessary engagement with legal counsel and/or Chief Administrative Officer as deemed appropriate.

Qualification and Experience

Qualifications: Bachelor's degree in business or health care and 5-7 years' experience in healthcare compliance, licensing, corporate operations, legal and/or pharmacy benefit management with demonstrated career progression and supervisory experience. Pharmacy benefit management administration, health plan administration, pharmacy benefit management compliance and licensure experience are musts. Regulatory research, interpretation and analysis skills, and downstream vendor monitoring also required. Preferred: Certification in Healthcare Compliance (CHC); or Certification in Healthcare Research Compliance (CHRC); or Certification in Health Privacy Compliance (CHPC); and/or Admission to the Minnesota Bar Association (JD Degree) and completion of master's or advanced degree such as MHA, MBA or JD, with a special focus in healthcare, pharmacy benefit management and/or legal and regulatory compliance.

Additional info

Job Number: 16-58757

Company info